A recent article published in the prestigious scientific journal The New England Journal of Medicine on January 7, 2022 clearly analyzes the advantages and disadvantages of rapid coronavirus tests, and sets out guidelines for their proper use and reliable evaluation. of their result. The Professors of EKPA Ourania Tsitsiloni, Evangelos Terpos, Ioannis Trougakos and Thanos Dimopoulos (Rector of EKPA) summarize the main points of the article.
To date, the World Health Organization (WHO) has recorded approximately 300 million confirmed SARS-CoV-2 infections and 5.5 million deaths from COVID-19. Specific tests for the virus are particularly critical in identifying people with COVID-19, in reducing the spread of the virus, and in informing the Public Health Services about controlling infections. Unfortunately, the low access of a large part of the population to diagnostic tests and the incomplete reporting of COVID-19 cases to the WHO indicate that these figures represent only a fraction of the total infections and deaths from the COVID-19 pandemic.
Today, the approximately 400 rapid tests approved by the US Food and Drug Administration (FDA) for the diagnosis of SARS-CoV-2 infection are divided into two types: (1) those that detect genetic material (ie. the genes) of the virus (molecular rapid test) and (2) those that detect protein-antigen viruses (antigen rapid rapid test).
Rapid tests are used by people with symptoms of COVID-19 (symptomatic people) and by people who do not have symptoms but have been in close contact with a case of COVID-19 or who have been exposed to a potentially high-risk transmission of SARS-CoV- 2, such as on an airplane or at a sports club (asymptomatic people).
The instruction algorithm for each case recommends the following:
1 Symptomatic individuals who develop any symptoms of COVID-19, regardless of their vaccination status, should undergo rapid testing as soon as possible, and remain in quarantine until their test results are confirmed.
- If the rapid test is positive, they must confirm the result with a molecular test (RT-PCR), remain in quarantine, notify health services and, if necessary, receive treatment. It is noted that in Greece it is not appropriate today to confirm with a molecular test a positive rapid test.
- If the rapid test is negative, they should be re-examined after 2 days, especially if they have symptoms that worsen or symptoms that indicate a high chance of coronavirus infection. If after 2 days the rapid test is negative, the infection is probably not due to SARS-CoV-2.
2 Asymptomatic individuals exposed to SARS-CoV-2 (ie in close contact with a confirmed COVID-19 case), regardless of their vaccination status, should be monitored immediately and within 48 hours with a rapid test, but also for a second time 5-7 days after their initial exposure, and remain in quarantine.
- If the first rapid test or rapid test after 5-7 days is positive, they should confirm the result with a molecular test (RT-PCR), remain in quarantine, notify the health services and, if they show symptoms, may need to receive treatment. It is noted that in Greece it is not appropriate today to confirm with a molecular test a positive rapid test.
- If the first rapid test is negative and they have no symptoms, they should be re-examined after 2 days, or at any time they show symptoms. If the rapid test is negative again, they should be monitored for symptoms for 14 days after exposure, and if they do not show symptoms, then they have not been infected with SARS-CoV-2.
3 Asymptomatic individuals found in a high-risk transmission environment for SARS-CoV-2 should be screened rapidly within 48 hours of exposure.
- If the rapid test is positive, should be repeated after 2 days, especially if COVID-19 is clinically suspected or if the prevalence of COVID-19 in the population is low. If the rapid test is positive again, then the infection must be confirmed by molecular control (RT-PCR), the person must be quarantined and notify the health services. If the repeat rapid test is negative, then there is no evidence of SARS-CoV-2 infection.
- If the rapid test is negative, then it does not need to be repeated and the person is not infected with the virus.
4 People with known exposure to SARS-CoV-2 who have not been vaccinated or who have not had a booster dose in the last 6 months and who have a positive rapid test should be quarantined pending the results of their molecular test (RT) test. -PCR), which is definitely recommended. They should also be monitored for symptoms.
5 People who are positive in any of the above cases, should be isolated, inform the health services and also inform their close contacts about their infection.
6 People undergoing rapid testing should be aware that rapid antigenic tests are less sensitive than molecular tests, but detect the infection earlier (5-7 days after the onset of symptoms), ie the time when the contagion due to high viral virus load is greater.
7 According to the US Centers for Disease Control (CDC) guidelines, people exposed to the virus should be tested twice, the first rapid test should be done within 48 hours and the second rapid test 2 days after the first negative test. However, if you want to do a rapid test only once, it is recommended to check it 5-7 days after the exposure.
8 In all of the above cases, tests that detect specific IgG or IgM antibodies to SARS-CoV-2 should not be used. Antibody tests do not detect acute infection.
9 It should also be clear that already approved rapid tests have been validated prior to the onset of the “delta” and “micron” mutations, and the FDA re-evaluates the sensitivity and specificity of all circulating rapid tests to reduce the likelihood false results.
10 Finally, the recommendation to the entire population is to be vaccinated with a booster dose as soon as possible, to limit their participation in rallies, and to strictly observe the sanitary measures.
Simplified Table as in force today in Greece
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